Lessons Learned from Our Second Opinion Cases: Advantages of Shared Decision Making for Complex Heart Diseases

Abstract

In the field of congenital heart surgery, it is often difficult to determine the best treatment option. For patients with complex heart disease or operative factors, we recommend obtaining a second opinion from the viewpoint of shared decision-making. In this study, we describe four second opinion cases, relating to congenitally corrected transposition of the great arteries (ccTGA): Transposition of the great arteries (TGA), TGA and pulmonary atresia (PA), hypoplastic left heart syndrome (HLHS) with total anomalous pulmonary venous connection (TAPVC), and a functional single ventricle with mixed TAPVC. In the ccTGA case, the patient preferred a double switch operation to conservative observation. The patient with TGA and PA underwent a Rastelli operation, which was the treatment option offered by the second opinion institution. In the HLHS with TAPVC case, the patient’s mother preferred treatment at another hospital, which had a previous Fontan survivor with the same disease. In the last case, the family felt embarrassed because the operation was considered impossible at first, but the patient was later told that surgery would be appropriate. Consequently, the family requested a second opinion from another hospital, where they were told that surgery could be performed, which they agreed to. All four cases relied on shared decision-making. Our findings show that information-sharing, and a sincere attitude towards patients is necessary for all medical workers.